Psychological symptoms in healthcare workers following the COVID-19 pandemic and relationship to long-term cardiovascular risk

Over the past year, the entire world has been upended by the COVID-19 pandemic. As of February 2021, there
have been over 112 million confirmed cases and over 2.5 million deaths globally. In New York City, the initial
US epicenter of the pandemic, there have been >700,000 cases, >89,000 hospitalizations, and >29,000
deaths. Healthcare workers (HCWs) have experienced alarming rates of anxiety, stress, and insomnia due to
COVID-19, which are likely to persist beyond the pandemic. In the proposed work, we will examine the
presence and predictors of long-term psychological symptoms and the consequences for cardiovascular health
among emergency department (ED) HCWs following the COVID-19 pandemic. This work is necessary to
understand the scope of the problem and to inform efforts to protect the health of these frontline HCWs who
have risked their lives to ensure our safety. Pre-COVID, ED HCWs were already known to be at greater
psychological risk than nearly every other subgroup of clinicians. Psycho-physiologic stress factors have been
dramatically magnified during the COVID period, in what has been referred to as a “parallel pandemic” of
surging mental and physical harm faced by HCWs. It is critical to understand the presence of sustained
psychological symptoms seen in HCWs who treated COVID patients, as well as downstream impacts on
cardiovascular health. Our preliminary work showed that HCWs experienced significant acute psychological
distress during the initial COVID peak in New York City. In a survey of hospital HCWs conducted in April
2020, we found high rates of acute stress disorder (65%), anxiety (36%), and insomnia (70%). Early evidence
points to persistence of psychological symptoms. In these participants, 25% experienced post-traumatic stress
disorder (PTSD) and 39% experienced insomnia at a 10 week follow-up. In the proposed study, we will (1)
examine the prevalence and predictors of sustained psychological symptoms in ED HCWs who provided care
during the COVID pandemic; (2) characterize the relationship of psychological symptoms to 3-year progression
of atherosclerotic cardiovascular disease (ASCVD) risk; and (3) examine a potential protective factor (i.e.,
resilient coping) in the development of COVID-related psychological symptoms. To achieve these aims, we will
conduct a prospective 3-year study of psychological and cardiovascular health in ED HCWs exposed to some of
the highest COVID case rates in the world. At study baseline (Year 0) and at each annual follow-up (Years 1-3),
we will conduct a thorough psychological test battery that includes measures of COVID-related PTSD, COVID-
related fear, insomnia, and resilient coping. Each participant’s ASCVD risk score will be computed annually.
Our primary exposure and predictor of psychological symptoms will be the computed “Covid burden,”
quantified as the number of shifts worked between March 1, 2020 (date of our hospital’s index case) and study
enrollment, in which COVID admissions exceeded 15% of total ED patients. Findings will inform interventions
to protect mental and physical wellbeing in HCWs as we navigate this and future public health crises.

Grant Number: 5R01HL157341-05
NIH Institute/Center: NIH
Principal Investigator: Bernard Chang